Vape Pens, e-Cigarettes the Smoking Gun Behind Youth Health Maladies

Although cigarette smoking has shown a marked decline in the United States in recent years, vaping has stepped in like a slick charlatan, wooing young people into an equally deadly habit. Educating navigators on electronic nicotine delivery systems (ENDS) and their dangers, Nancy Sayegh-Rooney, RN, ONN-CG, NCTTP, a lung nurse navigator, also shared information about prevention efforts and clinical implications of vaping.

“These products are not taxed, nobody knows what’s in them, and they don’t have to answer to any regulation,” Ms Sayegh-Rooney said. “It’s really scary stuff.”

When one considers that nearly all tobacco use begins during adolescence, it makes sense that ENDS are offered in a variety of enticing flavors that could seduce young tastes. Seemingly innocuous to young people, these palatable puffs represent a wolf in sheep’s clothing, Ms Sayegh-Rooney said. Thanks to targeted marketing, a 48% increase in vaping has been seen among middle school–aged children, and the Centers for Disease Control and Prevention (CDC) reports that the use of e-cigarettes increased by up to 78% among high school students between 2017 and 2018. In 2018, 27.1% of high school students reported use of any tobacco product. Of them, 20.8% used e-cigarettes.

The most popular among e-cigarettes, 1 Juul is equivalent to 3 packs of cigarettes, according to Ms Sayegh-Rooney.

“We’ve got an issue,” she said. “We’ve stopped talking, but we’ve got to continue the conversation with these kids. We need to explain to them, without our breath, we are nothing.”

While some may view vaping as relatively harmless because of the lack of foul-smelling smoke, this could not be further from the truth. Like traditional cigarettes, e-cigarettes contain nicotine, which is not only highly addictive but also can harm the developing brain, impairing learning, memory, and attention, according to Ms Sayegh-Rooney.

“It is a gateway drug to a lifetime of nicotine dependency. We’ve created a new generation of addicts,” she said.

Nicotine is not the only danger lurking inside ENDS, which include e-cigarettes and “pods.” The vapors being inhaled from these devices also contain glycerol, a colorless, sweet, viscous liquid. Formed as a byproduct of soap manufacturing, glycerol is used as an emollient and a laxative, and is also used for making explosives and antifreeze. Propylene glycol, a carcinogenic byproduct of fossil fuel, is often used to create polyurethane plastic, and is used in ENDS. Other unsavory ingredients include benzoic acid, a chemical used in insect repellent, and vitamin E acetate, a thickening agent often used in THC vaping products. Despite their toxic makeup, ENDS are only predicted to grow in popularity.

Advocacy efforts to quell the craze are underway, and seek to target the underlying drivers of vaping. So as not to reinvent the wheel, advocates are working on modernizing evidence-based tobacco-control strategies that have worked in the past. These include price increases, indoor-use restrictions, and educational campaigns, along with flavor restrictions to make ENDS less attractive to young people, said Ms Sayegh-Rooney.

“We all share an important responsibility to keep these harmful and addictive products out of the hands of our kids,” she added.

From a clinical standpoint, vaping raises considerable concerns. Most recent among them is the significantly increased risk for COVID-19 among teens and young adults who vape, according to a study conducted at Stanford University School of Medicine. The researchers found that among participants tested for COVID-19, those who had ever used e-cigarettes were 5 times more likely to be diagnosed with COVID-19 than nonusers. In addition, young people who had used cigarettes or e-cigarettes in the past 30 days were nearly 5 times as likely to experience symptoms of COVID-19, including coughing, fever, fatigue, and breathing difficulties, as those who never smoked or vaped.

Combine this added risk with the risk for “popcorn lung” or bronchiolitis obliterans, along with e-cigarette or vaping product lung injury (EVALI), and it becomes clear that vaping is a recipe for disaster. As of January 2020, 2602 cases of EVALI were reported to the CDC; 57 of those cases resulted in death.

Diagnosing EVALI can be a challenge, as symptoms mimic those of other respiratory illnesses, Ms Sayegh-Rooney advised.

“It’s similar to the illnesses of pneumonia and the flu,” she said. “It’s similar to what we see on a COVID x-ray.”

Treatment involves corticosteroids, antibiotics, and antivirals, she said, pointing out that follow-up is vital because data are pending on long-term effects.

“We don’t know how long their recovery will be. We don’t know what the long-term effect will be from this…diagnosis,” Ms Sayegh-Rooney said. “It’s really a scary time that these products are out there and our children, our grandchildren have access to them.”